Method for inhibiting hyperproliferative diseases
BRIEF SUMMARY OF THE INVENTION 
     The invention relates to a method of treating hyperproliferative skin diseases, such as psoriasis, with compounds of the formula ##STR5## wherein R 1  is hydrogen when R 2  is hydroxy and R 1  is methyl when R 2  is hydrogen; and A is alkyl; cycloalkyl; alkenyl; alkyl substituted with trifluoromethyl; phenyl; halophenyl; phenyl-C 1-3  alkyl; phenyl-C 1-3  alkyl substituted on the phenyl with 1 to 3 substituents selected from the group consisting of halo, C 1-3  alkyl, and C 1-3  alkoxy; or 
     A is ##STR6## wherein R 3  is hydrogen or ##STR7## R 4  is hydrogen or methyl, and n is 1 to 5; or the corresponding hydroxy acid of formula ##STR8## wherein A, R 1  and R 2  are as described above, or a pharmaceutically acceptable salt of said acid, an alkyl ester of said acid, an acetylamino-substituted-C 1-4  alkyl ester of said acid, a phenyl-dimethylamino ester of said acid or a α-monoglyceride of said acid. 
     BACKGROUND OF THE INVENTION 
     Compounds of formulas I-X and other mevinolin derivatives are known to inhibit the biosynthesis of cholesterol and thus are useful for their antihypercholesterolemic activity. (see U.S. Pat. No. 4,444,784 issued to Hoffman et al on Apr. 24, 1984 and U.S. Pat. No. 4,450,171 issued to Hoffman et al on May 22, 1984). The compounds of formula I-X may be isolated from the microfungus of the genus Aspergillus as described in U.S. Pat. Nos. 4,231,938 issued to Monaghan et al on Nov. 4, 1980 and U.S. Pat. No. 4,294,926 issued to Monaghan et al on Oct. 13, 1981. 
     The most active member of this group of natural compounds in inhibiting cholesterol biosynthesis has a mevinolin structure. (see U.S. Pat. No. 4,450,171, col. 1., lines 43-51; also see U.S. Pat. Nos. 4,444,784; 4,293,496; 4,450,171; 4,582,915; 4,231,938; 4,294,926; and 4,668,699 hereby incorporated by reference). As antihypercholesterolemic agents, these known compounds may be administered orally or parenterally, although the oral route is generally desirable. Moreover, the known compounds have been found to be useful as anti-fungal agents which may be sprayed or dusted on plants to be protected. (see U.S. Pat. No. 4,450,171, col. 12, lines 45-66). 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The invention relates to a method of treating hyperproliferative skin diseases, such as psoriasis, with compounds of the formula ##STR9## wherein R 1  is hydrogen when R 2  is hydroxy, and R 1  is methyl when R 2  is hydrogen; and A is alkyl; cycloalkyl; alkenyl; alkyl substituted with trifluoromethyl; phenyl; halophenyl; phenyl-C 1-3  alkyl; phenyl-C 1-3  alkyl substituted on the phenyl with 1 to 3 substituents selected from the group consisting of halo, C 1-3  alkyl, and C 1-3  alkoxy; or A is ##STR10## wherein R 3  is hydrogen or ##STR11## R 4  is hydrogen or methyl, and n is 1 to 5; 
     Preferred compounds of the formula I are compounds of formula ##STR12## 
     The corresponding hydroxy acid of formula I is ##STR13## wherein A, R 1  and R 2  are as described above, or a pharmaceutically acceptable salt of said acid, an alkyl ester of said acid, an acetylamino-substituted-C 1-4  alkyl ester of said acid, a phenyl-dimethylamino ester of said acid or a α-monoglyceride of said acid. 
     Preferred compounds of formula II are compounds of formula ##STR14## 
     It has been unexpectedly found that compounds of formulas I-X are useful in the treatment of hyperproliferative skin diseases, such as psoriasis, basal cell carcinomas, squamous cell carcinomas, keratosis, and disorders of keratinization. These compounds may be administered either orally or topically. 
     Compounds of formulas I and II wherein R 1  is methyl and A is as described above may be prepared by methods disclosed in U.S. Pat. No. 4,444,784 and 4,450,171. 
     Compounds of formula I are converted into the compound of formula II in a manner analogous to that discussed in U.S. Pat. No. 4,444,784. 
     Compounds of formulas V, VI, IX and X may be prepared by known methods discussed in U.S. Pat. No. 4,346,227. 
     &#34;Normal skin&#34; is skin which undergoes a sequence of changes resulting from changes in the proliferative basal cells to the formation of terminally differentiated corneocytes. As the epidermis differentiates in the skin, keratinocytes undergo a destructive process of terminal differentiation to produce the acellular protective layer of the stratum corneum. The process begins with the basal layer of cells proliferating and entering into the spinous layer of the skin. Within the spinous layer there is increased metabolic activity with a concomitant increase in the precursor protein for the cornified envelope and changes in the keratin expression. As the cells pass higher up the skin into the stratum corneum, enzymes responsible for crosslinking envelope proteins are active, profilaggrin processing is initiated, and higher molecular weight keratins appear. As the cell passes into the stratum corneum it is converted into a keratin filled, cornified envelope without nucleus or other organelles. 
     As used herein, the term &#34;psoriasis&#34; refers to a hyperproliferative skin disease which alters the skin&#39;s regulatory mechanisms. In particular, lesions are formed which involve primary and secondary alterations in epidermal proliferation, inflammatory responses of the skin, and an expression of regulatory molecules such as lymphokines and inflammatory factors. Psoriatic skin is morphologically characterized by an increased turnover of epidermal cells, thickened epidermis, abnormal keratinization, inflammatory cell infiltrates into the dermis layer and polymorphonuclear leukocyte infiltration into the epidermis layer resulting in an increase in the basal cell cycle. Additionally, hyperkeratotic and parakeratotic cells are present. 
     The terms &#34;keratosis,&#34; &#34;basal cell carcinomas&#34; and &#34;disorders of keratinization&#34; refer to hyperproliferative skin diseases in which the regulatory mechanisms for the proliferation and differentiation of normal skin cells are disrupted. 
     The compounds of formulas I-X are active as skin hyperproliferation antagonists, that is, as agents which decrease the proliferation of human keratinocytes. The compounds further antagonize alterations in the differentiation of keratinocytes. Accordingly, the compounds are useful as agents for the treatment of hyperproliferative skin diseases such as psoriasis, basal cell carcinomas, disorders of keratinization and keratosis. 
     As used herein the term &#34;halo&#34; means chloro, fluoro, bromo, or iodo. 
     As used herein the term &#34;alkyl&#34; denotes a straight or branched chain saturated hydrocarbon having 1 to 10 carbon atoms such as methyl, ethyl, propyl, isopropyl and the like. 
     The term &#34;cycloalkyl&#34; denotes a cycloalkyl having 3 to 10 carbon atoms such as cyclopropyl, cyclobutyl, and the like. 
     The term &#34;alkenyl&#34; denotes a straight or branched chain alkenyl having 2 to 10 carbon atoms such as ethenyl, propenyl and the like. 
     The term &#34;alkyl substituted with trifluoromethyl&#34; denotes a C 1-10  straight or branched chain alkyl having one hydrogen replaced by trifluoromethyl. 
     The term &#34;halophenyl&#34; denotes a phenyl substituted with up to three halogens. 
     The term &#34;phenyl-C 1-3  alkyl&#34; denotes an alkyl having 1-3 carbon atoms and one of whose hydrogens is replaced by a phenyl. 
     The term &#34;corresponding hydroxy acid of formula I&#34; denotes a compound of the formula ##STR15## wherein A, R 1  and R 2  are as described above. 
     In the formulas presented herein, the various substituents are illustrated as joined to the carbon framework by one of the following notations: a solid line () indicates a substituent which is above the plane of the molecule (β-orientation) and a dotted line () or () indicates a substituent which is below the plane of the molecule (α-orientation). 
     The invention relates to a method for treating hyperproliferative skin diseases which comprises administering an antihyperproliferatively effective amount of a compound of formula ##STR16## wherein R 1 , R 2  and A are as described above, or the corresponding hydroxy acid of the formula ##STR17## wherein R 1 , R 2  and A are as described above or a pharmaceutically acceptable salt of said acid, an alkyl ester of said acid, an acetylamino-substituted-C 1-4  alkyl ester of said acid, a phenyl-dimethylamino ester of said acid or a α-monoglyceride of said acid. 
     The invention also relates to oral and topical compositions comprising an effective amount of a compound of formulas I-X. 
     Preferred are compounds of formulas I and II wherein R 1  is hydrogen when R 2  is hydroxy or R 1  is methyl when R 2  is hydrogen. 
     Especially preferred of the compounds of formula I is the compound of the formula ##STR18## which is referred to herein as mevinolin; and also especially preferred of the compounds of formula I is the compound of the formula ##STR19## which is referred to herein as synvinolin. 
     The compounds of formulas III and IV are known or can be prepared in accordance with known methods, such as those described in U.S. Pat. No. 4,346,227. 
     Effect of Compounds of Formulas I-X on the Proliferation of Cultured Human Keratinocytes 
     The compounds of formulas I-X as described above can be administered orally, for the treatment of hyperproliferative skin diseases such as psoriasis, basal cell carcinomas, squamous cell carcinomas, disorders of keratinization and keratosis to warm-blooded animals which need such treatment. While dosages may vary depending upon the severity of the disease, the compounds of formulas I-X can be administered orally to the adult human in dosages that are in the range of about 10 to 80 milligrams per day and preferably about 10-50 milligrams per day for the treatment of hyperproliferative skin diseases such as psoriasis, basal cell carcinomas, squamous cell carcinomas, disorders of keratinization and keratosis. 
     The compounds of formulas I-X as described above can be administered topically, for treatment of hyperproliferative skin diseases, such as psoriasis, basal cell carcinomas, squamous cell carcinomas, disorders of keratinization and keratosis to warm-blooded animals which need such treatment. While dosages may vary depending upon the severity of the disease, the compounds of formulas I-X as described above can be administered topically in dosages that are about 1 to about 200 micrograms of compounds I-X per gram of topical formulation per day for the treatment of such diseases, preferably about 1 to about 50 micrograms of the compounds of formulas I-X per gram of topical formulation per day are administered to a patient. 
     The useful activity of compounds of formulas I-X as agents for the treatment of hyperproliferative skin diseases are demonstrated by the following test procedures. 
     Materials &amp; Methods 
     1. Culture Conditions 
     Human neonatal foreskins were collected by circumcision and placed into tubes containing DMEM media. Upon arrival at the laboratory the foreskins were mechanically trimmed of excess dermis and treated with a solution of trypsin/EDTA (0.05%/0.02%) at 4° C. overnight. The epidermis was stripped from the dermis, agitated in buffered saline to remove basal keratinocytes and to separate the stratum corneum which was subsequently removed. The separated cells were centrifuged, resuspended in media, counted and the keratinocytes were plated onto a plain plastic culture dish. 
     The keratinocytes were plated at a density of about 10 5  cells/cm 2  in 35 cm 2  dishes. The cells were grown in keratinocyte growth media (KGM®-modified MCDB 153 containing antibiotics by Clonetics of Boulder, Colo.) according to protocols originally developed by Boyce, S.T. and Ham, R.G., J. of Tissue Culture Meth. 9:83-93 (1985). The cells were grown for 5-10 days and changed every 2-3 days with keratinocyte growth media with 1.5 mM CaCl 2  (hereinafter KGM®/1.5 mM CaCl 2 ) until cells reached a 75% confluency by visual observation. All the cultures were incubated in a humidified atmosPhere of 5% CO 2  at 37° C. 
     To establish keratinocyte cell cultures as antiproliferative assays, cells prepared as described in the foregoing were washed with PBS and removed from the culture surface with a solution of trypsin/EDTA (0.25%/.0.03%). The removed cells were then centrifuged, resuspended in the KGM®/1.5 CaCl 2  and counted. The cells were then distributed to 6 well plates at 100,000 cells per well as described in the foregoing. Each well had an area of 9.5 cm 2 . After 24-48 hours fresh KGM®/1.5 mM CaCl 2  which contained test compounds was added to the cells. The cultures were maintained for seven days. The media and test compound was changed every 2-3 days. 
     Solutions of the test compounds were prepared as follows: 1 milligram quantities were received in amber glass vials, and stored at -20° C. Sufficient 100% ethanol was added directly to vials to obtain a millimolar solution that was subsequently aliquoted into small amber vials, overlayed with argon gas and stored at -20° C. Each stock solution was thawed once, used and discarded. Aliquots from the stock solutions were diluted directly into medium and then serially diluted from micromolar to 10 -12  M concentrations. Dilutions from 10 -7  M to 10 -12  M had ethanol added for a final concentration of 0.1%. Stock solutions were used within one month. Control cultures were treated with 0.1% ethanol. 
     3. Cell Proliferation 
     For each experiment every culture well received the same number of cells from the same culture source. At the termination of the experiment the number of cells per was determined by the following procedure. Wells were washed twice with PBS and then incubated for approximately 10-20 minutes at 37° C. with a trypsin/EDTA solution (0.25%/03%). PBS plus 0.1% soybean trypsin inhibitor was added and the cells were suspended. An aliquot of the cells was placed into isotonic buffered saline and counted on an electronic particle counter (e.g. Coulter Counter® device by Coulter Electronics of Hialeah, Fla.). 
     Quantification of proliferation was done by enumerating the number of keratinocyte cells in each well using the Coulter Counter®. Results shown in Table 1 below show the percent reduction or inhibition of keratinocyte cells calculated for each of 4 concentrations of the compounds tested according to the formula: ##EQU1## 
     For statistical analysis, the mean was calculated for all wells in each treatment group. Standard deviation was determined by nonbiased analysis using a value for the number of wells in each group, which was 3. 
     
                       TABLE 1                                                     
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INHIBITION OF COMPOUNDS OF FORMULA I on                                   
KERATINOCYTE PROLIFERATION                                                
           Dosage     Percent Inhibition                                  
           of Compound                                                    
                      on Keratinocyte                                     
                                   Standard                               
Compound   (M)        Proliferation                                       
                                   Deviation                              
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1. ETOH Control       0.00         24.48                                  
2. Mevinolin                                                              
           10.sup.-10 23.2         26.7                                   
           10.sup.-8  28.9         17.57                                  
           10.sup.-7  38.6         12.82                                  
           10.sup.-6  84.21        14.51                                  
3. Synvinolin                                                             
           10.sup.-10 0.00         24.08                                  
           10.sup.-8  11.17        26.42                                  
           10.sup.-7  33.60        26.34                                  
           10.sup.-6  62.06        24.31                                  
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     Each compound is tested in triplicate, at each concentration. 
     Conclusion 
     The foregoing results evidence that compounds of formula I at a dosage of 10 -6  M inhibit keratinocyte cell proliferation at a rate greater than 50% without toxicity to the cells. For example, mevinolin at this dosage inhibits 84.21% of keratinocyte proliferization and synvinolin inhibits 62.06% of keratinocyte proliferization at this dosage. 
     These data indicate that the compounds of formula I restrain the proliferation of human keratinocyte cells in vitro, without toxicity to the cells. From these results it can be seen that each of the tested compounds is useful as an agent in the treatment of hyperproliferative skin diseases such as psoriasis. 
     As pointed out above, it is known that compounds of formula I are useful as cholesterol lowering agents. It is also known that corresponding hydroxyacids of formula II are useful as cholesterol lowering agents. 
     In the present invention it has been found that compounds which have cholesterol lowering activity are also useful in the treatment of hyperproliferative skin diseases. 
     Dosage Forms 
     Oral dosage forms comprising compounds of formulas I-X of the invention may be incorporated in capsules, tablets and the like with pharmaceutically acceptable carrier materials. 
     Illustrative of the pharmaceutically acceptable carrier materials which may be incorporated into capsules, and the like are the following: a binder such as gum tragacanth, acacia, corn starch, or gelatin; an excipient such as dicalcium phosphate; a disintegrating agent such as corn starch, potato starch, algenic acid, and the like; a lubricant such as magnesium stearate, a sweetening agent such as sucrose, lactose, or saccharin; a flavoring agent such as peppermint, oil of wintergreen or cherry. Various other materials may be present as coating or to otherwise modify the physical form of the dosage unit. For instance, tablets may be coated with shellac, sugar, or both. A syrup or elixir may contain the active compound, sucrose as a sweetening agent, methyl and propyl parabens as preservatives, a dye, and a flavoring such as cherry or orange flavor. 
     A preferable formulation for an oral dosage of the compound of Formulas I-X in capsule form is presented in Example 1 below: 
     Example 1 
     Oral dosage formulation (capsule) for Compounds of Formulas I-X. 
     
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1.    Compound of Formula I, II,                                          
                        20 milligrams                                     
      III, IV, V, VI, VII, VIII,                                          
      IX or X                                                             
2.    Lactose hydrose   150 milligrams                                    
3.    Starch            30 milligrams                                     
4.    Talc              20 milligrams                                     
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     Manufacturing Process 
     A. Mix 1 with a portion of 2. 
     B. Add 3 and 4, and mix. 
     C. Add the remainder of 2, mix thoroughly, and pass through a suitable mill. Capsules are filled with the composition thus prepared. 
     Topical dosage forms comprising compounds of formulas I-X of the invention include: ointments and creams encompassing formulations having oleaginous, adsorbable, water-soluble and emulsion-type bases such as petroleum, lanolin, polyethylene glycols and the like. 
     Lotions are liquid preparations and vary from simple solutions to aqueous or hydroalcoholic preparations containing finely divided substances. Lotions can contain suspending or dispersing agents, for example, cellulose derivatives such as ethyl cellulose, methyl cellulose, and the like; gelatin or gums, which incorporate the active ingredient in a vehicle made up of water, alcohol, glycerin and the like. 
     Gels are semi-solid preparations made by gelling a solution or suspension of the active ingredient in a carrier vehicle. The vehicles, which can be hydrous or anhydrous, are gelled using a gelling agent, such as carboxy polymethylene, and neutralized to a proper gel consistency with the use of alkalies, such as, sodium hydroxide and amines, such as, polyethylenecocoamine. 
     As used herein, the term &#34;topical&#34; denotes the use of the active ingredient, incorporated in a suitable pharmaceutical carrier, and applied at the site of inflammation for the exertion of local action. Accordingly, the topical compositions include those pharmaceutical forms in which the compound is applied externally by direct contract with the skin. The topical dosage forms comprise gels, creams, lotions, ointments, powders, aerosols and other conventional forms for applying medications to the skin obtained by admixing the compounds of formula I with known pharmaceutical topical carrier materials. In addition to the application to the skin, the topical compositions of this invention can also be employed in the treatment of inflammations of mucous membranes, where such membranes are accessible to topical application of medication. For example, the topical composition can be applied to the mucous lining of the mouth or lower colon. 
     A preferable formulation for a topical dosage of the compounds of Formulas I-X is presented in Example 2 below: 
     Example 2 
     Preferred Formulation for Topical Dosage of Compounds of Formulas I-X 
     
         ______________________________________                                    
1.   Compound of Formula I, II,                                           
                        10.0       micrograms                             
     III, IV, V, VI, VII, VII,                                            
     IX or X                                                              
2.   Stearyl alcohol    4.0        g                                      
3.   Cetyl alcohol      4.0        g                                      
4.   Mineral oil        3.0        g                                      
5.   Polysorbate 60     4.5        g                                      
6.   Sorbitan stearate  4.5        g                                      
7.   Propylene glycol   10.0       g                                      
8.   Methyl paraben     0.18       g                                      
9.   Propyl paraben     0.02       g                                      
10.  Water              q.s. to 100.00                                    
                                   g                                      
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     Manufacturing Process 
     A. Heat 2 through 6 to 80° C., which melts all ingredients (oil phase). 
     B. Dissolve 1 in oil phase. 
     C. Heat 7 and 10 to 90° C (aqueous phase). 
     D. Dissolve 8 and 9 in aqueous phase. 
     E. Add aqueous phase to the oil phase and stir rapidly to form emulsion. 
     F. Cool slowly to 50° C. to allow to congeal. 
     G. Continue stirring slowly to room temperature.